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HomeMy WebLinkAbout18236-z roam xo. s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N ° ~ 8 ~ ~ ~ Z Date ..~~d 19!pl... Permission is hereby gronte to: ~::.d,..~. . ~ ct premises located at ...~~...:~~i~//1.~~.~~. ~~K:!:..~.....'4~ FSL: K.'Y~(.(~ County Tax Map No. 1000 Section ........~1.....tl......... Block Lot No.....~~.-'~. pursuant to application doted ..................~A...rl..~~,.~..................., 19.0?, and approved by the Building Inspector. pp~~ 0 Fee $..af,.s D ..~r I.. .d"5~~ d~d'~ ~ uildi I for Rev. 6/30/80 BOARD OF HEALTH - 3 SETS OF PLANS FORM N0.1 SURVEY TOWN OF SOUTHOLD CHECK ~~Q~~:.. BUILDING DEPARTMENT SEPTIC FORM TOWN HALL NOTIFY ~OUTHOLD, N.Y. 11971 CALL TEL.: 765-1802 MAIL T0: Examined . ~lt./~~.D......., 19Q./ Approved ../p/.?~1........, 19~. Permit No. F.Q.z.J~, Disapproved a/c f'l.~ ~ ~ ~ '°'C3fa;G.OF'7. ~ TO~'(U OF SOUTti0L0 _,wm___ .U,..,~..a a.,,. i . .P~,......... . D% l ilding Inspector) APPLICATION FOR BUILDING PERPAIT Datc ` 19~~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. E to the Building Department for the issuance of a Building Permit pursuant to the B ~ rx ! I~ of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or R 'o ~~tt~c uildings, additions or alterations, or for removal or demolition, as herein described. T p art wall applicable laws, ordinances, building code, housing code, and regulations, and to ad~a t>s and in building for necessary inspections..~-~ IiIE Ct>~E6rF.1! ldf7M!»''O' v. r e r. . t ,.cam. J. 5-r~ rY~ 5 . ~ ttilVi' ~rf#MJ' (Signatu~f applicant, or na~e, if a corporation) 3 (N4+d11iYUUM a (Mailing address of applicant) St~~~~`5s~~' ` ~lr~ s~rEvr,see, agent, architect, engineer, general contractor, electrician, plumber or builder. ,r,~ 141 ~>~~%rrral~la ~+a ~.,.._.,._....,,..t Nan'se`~bf owner of prc~is~s ..~,...e_.. ca ~ C!. tr-e.ya.a . ~~~D (as on the tax rol~r latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No. j . Plumber's License No . . Electrician's License No . . Other Trade's License No . . 1. Location of land on which proposed w\or/k will be done . . House Number Street Hamlet ~~7 County Tax Map No. 1000 Section ...mZ.f~ Block ~ Lot -T.~".~~J . Subdivision Filed Map No. Lot............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed constructjon: i ` ' a. Existing use and occupancy .......W r~.~,,++.r..5..ii.e>. ~ in, .a :T: , , ~ ~h ~ nci ..t-+. e-.~ r,~.kan T . b. Intended use and occupancy S..i ~ as 1 .o .r..l.ir~ . YJe,~.va,1C,.er, ,7).~-,~~ .°~:.p.W.ry~f,-'' W ~ 7' h ~-c-r~r . 3. Nature of work (check which applicable): New Building Addition . l Alteration . Repair Removal , Demolition l ...Other Work . I (Description), 4. Estimated Cost ~ Q A eS b Fee ~.?J"~. c 4................. (to bad paid on filing this application) If ara e, number of cars ~......p Y, .p ...Y . . . yts on each floor ; : ; g g , 6. If business, ommerco~aldoremixed occu anc s ectf nature a d extent ofleach t pe of use . . 7. Dimensions of extstmg structures, tf any: Front ...............Rear . , , . , Depth . Height ...............NumberofStories.........................: Dimensions'of same structure with alterations or additions: Front Rear . . Depth ......................Height Number o£ Stories . S. Dimensions of entire new construction: Front Rear ; .......Depth . Height ...............NumberofStories...........................1..........................'.. 9. Size of lot: Front Rear Depth . 10. Date of Purchase . 11. Zone or use district in which premises are situated 12. Does ro osed construction violate an zomn law ordinance or Fe ulationWner p P Y g . g N~ 13. Will lot be regraded _ d from premises: Yes No p Address ...Y .JJaoQ. PhoneNo.~.~3.°3:7,~f,'7' 14. Name of Owner of remises • ; ~ , Addressxcess fill4~rem~h~.: Phone No . Name of Architect . Name of Contractor~c.cur,r+~ 1'e.nexi,~. s~em~Address~a.lti:SS-'.S`.S~.~t~~a~elPhoneNo..'?45..7.4`tts. 15. Is this property located'-(iithin 30Wfeet of a tidal wetland? *Ycs No '11).,x, *If yes, Southold Town Trustees Permit ma be reqgu~ired. ~i PLO DIAGRAM Locate ~ 1 b g whether existing or proposed, and. indicate all set-back dimensions from proms ~~nd k~ escription according to deed, and show street names and indicate whether intenor c NEE: B ~y; i bE A 7815-1804 8 +4M 7~ 4 PMI THE fOL1,triMNO tNBPECt10N8: i. FOUNDATIgN 1~fiK?IIEf~NEIlD ROiR Rd1111ER E'ON~,MIRT# 2. ROUGH ~ t1tA1MM10 ~ ~LUEAaMp i 4. trlNAl t~NSTRUCTgMt1M1~T O cvv~ C.f S 'l ~ 1 ~ ~ n 37°4CIZb~~-+ ~liOMMlTf IOR C.A W o. c. K ) c i f~.~„~, W + f ALL CON~'fRFICpON 1 M1~1' ~ w , d-e, re ~rvrrl fir. ovsh¢,r~S s¢,PairO•'~ cooEl. Molt 6`~e 1 n , 1, DESIt3M OII I~ONf1111NtiM1~! ©w ter s ~ ~ bo H°u5~ }~avSeJ ~ ' ~ I a~vJ t.,w,n ~ ~-•r•5To.~ 1«r'~ an o-?•- o, (J~~ oY~~rna.T'eJ~~ h i ne-~ -~•~~..x o-}~ l X ~cro'T- h ~ qh ,Jff (('1` ~ J + J J GP._.~~f" STC9 CVSRe~yEy. r~G1nC`-~ ~eLT U.~ i%'1 QWhG!'~$ ~q G1L` ~OT p~hd r+e.,St, 6 a r_'s ~ o Y, ~-,JJe.~..~1~ WSJ v rv~.~e,.c( ~ re~, e. 1 ~ ...e.. STATE OF NEW YORK, S S COUNTY OF ein dul sworn de o, g y p I'sesandsaysthatheistheapplicant (Name of individual signing contract) above named. He is the • (Contractor,'agent, corporate officer, etc.)I of said owner or owners, and is duly authorized to perform or have performed the skid work and to make and file this application; that all statements contained in this application are true to the best of his'',knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. I Sworn to before me this ! I.r~.-. .........day of.. ~!K~,~.........., 19~~ N,o~tary Public, ..........a~Q~~ County ~ ] LINDA J. COOPER (Signature of applicant) Notary public, State of Newyork Term Exp+res Decembe 31~ tn9ry,~(~ ~i